Gawande cites a nutritionist who spent his career attempting to reduce hunger in Vietnamese villages. This man asked villagers to identify which families had the best-nourished children to determine a “positive deviance” from the norm. The answer was that those children’s mothers did not act in accordance with accepted village wisdom had the best outcomes. Rather, they fed their children even when they had diarrhea; fed them several small meals daily rather than one or two large ones; and fed their children foods that others considered low class but were nutritious such as sweet potato greens.

In the American healthcare system, the positive deviants resist the tendency to view patients primarily as revenue streams – but as human beings. Rather, these physicians deliver high-value healthcare without focusing too strongly on their practices’ bottom lines; they neither over-treat nor under-treat their patients with extraneous but profitable tests and procedures.

To quote Gawande, “Look for those in your community who are making healthcare better, safer and less costly. Pay attention to them. Learn how they do it. And join with them.”

ALTER+CARE's Inspire is a conversation about healthcare that reports and recognizes not only the challenges in our sector
but also sees the great potential and promise we see to improve patient care through a strategy that integrates capital,
buildings, physician recruitment, administration and outcomes. Join the discussion . . .